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Page: of 250
an lrg tRecord of Funeral.
Charye to .
} Order Given by ..
. How Secured Price of Casket or Coffin
“Metallic Lining H Dat r Date of Funeral “Outside Box
__ ' Place of Death “Grave Vault
——Funeral Services at ‘“* Burial Robe .
—_———e i Time of Funeral Services “Burial Slippers and Hose ed [a
{
Engraving Plate Cle
) reo . Embalming Body (with
~ Certifying Physician. Washing and Dressing. . . . . . . 7
His Residence Shaving .
Z a Number of Burial Certificate Keeping Body on kee cere oe
an a Cause of Death Disinfecting Rooms ee an
a D Death Use of Catafalque and Drapery . a _
a _ fn oe ‘* Folding Chairs a
ne as Occupation of the Deceased ** Candelabram nine ie ct
Single or Murried Religion. Candles .
, Aged.. Years, _. Months, Days. poet a ( oes
.
rape ‘ © es &8 »& a _
Body to be shipped to Number of Cariaps e$ an .
ia Size and Style of Casket or Coffin Hearse . ok
.
Wagon Deliveries.
Manufactured by
Death Notices ttt.. Newspapers . . . ——
Metallic Lining ,
(Names of erneapets
“ee oe ; Flowers ‘ oe . sone
le . Outside Box Outlay forLot. . . 2 os
att Nz Number of Handles Opening Grave. 6 ew ew Po .
i _ Interment at Cemetery. . Lining Grave . ee
; Shipping Charges, prepald Lot or Grave No.___. Section No,
en anne P
Removal Charges . . . . . . fl ne
— eo 4 Cremation Charges . el
— —
2.
,
re . . 3
i ee :
4,
a — 5.3. \7./. 50 6. . Total Footing of Bit. . . . . $hO27,
ees a woilgan ot en By Amount Paid in Advance . ee nee
Designate all Graves in Lot with Numbers (1, 2, 8, 4, ete.). and mark
es ae —_ space for this Funeral with a cross oo. * Balance en eee
Designate place for M t with a small 0).
», Use aoe’ right of Diagram tor the namin ofthe buried in Lot. . Entered into Ledger, page......or below. . __. os
. a 14 Lt. To Funeral Charges. Total, $ a OD By Cash $
loeeeuennicconaeill ravoneesbs sai 4
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